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Given that the ARVs have been around only about 15-20 years and no one knows, with surety, what their long term toxic effects are, I find it a tad disingenuous and possibly misleading for Dr. Fauci to claim that a 20-something year old diagnosed today can expect to have a life-expectancy of another 50 years.

Statistics/models and projections are nowhere near the same thing as real life experience.

I caught that too and was thinking the same thing. However, even if its true that its 50 years...its progress. At least now those who start treatment have a lot of hope for being able to see what other treatments will come along. Its come such a long way but still has much farther to go.

Personally I love it when scientists and doctors with a big investment and knowledge of HIV give out that normal life-span prognosis.

Its very encouraging to each person and there are political and epidemiological agendas that are served by this prognosis.

Yes, I see your point but there are certain downsides too:-

- Telling people you can live another 50 years can have a rather counter-producitve effect of making people complacent regarding their sexual health, particularly high-risk groups. Also, even if it is a good prognosis- nothing, absolutely nothing compares with being HIV negative and not having to worry about popping pills everyday and the crippling social consequences. Such a message, inaccuracies notwithstanding, can trick young sexually active people into thinking HIV is not a big deal- and that is contraray to every public health and political agenda any Government has.

-50 years or whatever, based on today's meds, is a model/projection/ estimate and nothing else. It is not set in stone in any way. There are too many variables that need to be considered.

So I guess it's a tricky balancing act from a Public Health Policy standpoint. The message to those infected needs to go out that one can still lead a relatively normal life-span and 'near-normal' quality of life, but at the same time the general population should not be led to believe that HIV isn't a big deal- cos that couldn't be further from the truth,.

In any event, all political agendas the world over will always lay more emphasis on curtailing the spread of the virus and thus will see to it that there is no shift in public perceptions that HIV isn't a big deal in 2011 and onwards, and this in my view is correct policy.

Even if it were the case that telling people the life expectancy was 50 years did cause people to act irresponsible sexually I do not believe that is a valid reason to not make the statement (if it is infact true). If anyone out there would know if it was true it would be Dr Fauci. He has been the director of the NIAID since 1984.

I trust his judgement. His experience affords him the designation of an expert.

I'm just saying that 50 years is an estimate/projection and is not a hard, verifiable, incontrovertible FACT.

I am all for him making such statements. I just don't think any Govt would be in favour of putting such a positive spin on 'Living with HIV' - and their reasons are valid.

It's a tricky balancing act from a Public Health Policy perspective. Sexual Health Message anywhere will always reflect a 'prevent new infections as effectively as possible' slant in the mind-set of policy-makers, the great strides in HIV science notwithstanding.

I understand what you are saying. Is it not a fact though? I recently recall an article that repeated the very same figures that Dr Fauci referred to (albeit I am sure he was referring to patients in treatment, newly diagnosed, in the U S). Here is the article

Given that the ARVs have been around only about 15-20 years and no one knows, with surety, what their long term toxic effects are, I find it a tad disingenuous and possibly misleading for Dr. Fauci to claim that a 20-something year old diagnosed today can expect to have a life-expectancy of another 50 years.

Statistics/models and projections are nowhere near the same thing as real life experience.

All life expectancies are merely projections. Any individual's and any group's experience will always differ in real life.

Nobody is announcing this as a fact. OBVIOUSLY. Because its the future.

Yes, the messages are conflicting but thats life. HIV is complicated and people just have to deal with complicated messages.

Its not right to just use scare tactics for safe sex agendas. But hide the good news.

On the contrary, it is factual that life expectancy is higher. That's because life expectancy is a defined construct. As such it is useful for understanding your potential future, but it does not define it.

Life expectancies are defined based on the experience of groups and can change as new information comes in. Recently life expectancies have changed mainly in the direction of longer expected lifetimes however.

Many people on this site seem to think that calculated life expectancies for people with HIV should be decreased to account for unobserved long term drug toxicity. What they fail to consider is that existing drug toxicity is already baked in to the calculations and that long term toxicity might just as well decline as increase -- after all, drugs evolve in favor of less toxic ones over time.

Life expectancies are defined based on the experience of groups and can change as new information comes in.

Not that I get some joy in arguing for the sake of it, but my point is that 'no group' has experienced popping ARVs for 20 years or more and therefore, in my opinion, for an expert to say that one can safely do it for 50 years (taking into account drug toxicity) is a projection that is more of an estimate than anything warranting the 'factual' label.

Dr. Fauci is more qualified than most to make this estimate, but at the end of the day it is still an estimate even if it comes from the most brilliant mind- there is always a margin of error when it comes to science.

I don't beleive thats actually true. From my understanding scare tactics are one of the least effective forms of prevention (most people never think it could happen to them).

Smoking rates dipped in Europe when there were adverts showing that guys couldn't get it up, girls worried about their appearance stopped smoking when they showed how smoking causes aging of the sking.

Not that I get some joy in arguing for the sake of it, but my point is that 'no group' has experienced popping ARVs for 20 years or more and therefore, in my opinion, for an expert to say that one can safely do it for 50 years (taking into account drug toxicity) is a projection that is more of an estimate than anything warranting the 'factual' label.

Dr. Fauci is more qualified than most to make this estimate, but at the end of the day it is still an estimate even if it comes from the most brilliant mind- there is always a margin of error when it comes to science.

Ah, but there are always reasons to disregard current events and substitute a more pessimistic view. Humans are capable of endless reasons to see a glass half full. My point is that:1) That is a lopsided view that substitutes unsubstantiated future fears for actual current data and trends. 2) It ignores the possibility that the event won't be harmful if it should occur3) It ignores the fact that when things go wrong people work on fixing them4) It implies a "specialness" about HIV treatment that does not, in fact, exist.

A little more about this last point. Should we ignore life expectancy statistics for all men because in the last 10-15 years men have increasingly been put on a lifetime dose of a statin starting in their late 40's? Should we decrease life expectancies because daily aspirin has become more common? Both of these could cause long term drug toxicity as well. (and what about proton pump inhibitors, erectile dysfunction drugs?, hair regrowth drugs?, we are an increasingly medicated society as a whole....)

But that misses the point that life expectancy is designed to be a measure of the future based on what is currently observed about a population (including currently observed trends) so that one can compare different groups objectively. What you have suggested is not a general measure of life expectancy that can be compared with data on other groups but a special "life expectancy with added unobserved HIV fears but no added unobserved causes for extra hope".

People with HIV are not alone in criticizing life expectancy studies because they do not include some factor that could affect life expectancy in the future. Often the criticism reflects some degree of unexamined personal fears.

But what this current data says is rejoice!

Based on current observations of data on chances of living and long term trends for those taking HAART, your life chances are just about as good as the population at large. Yes things could get worse, but they could also get better

(A final note, Dr. Fauci is likely basing his opinion on the studies performed by experts in life expectancy who have looked closely at the recent data, including in particular the European data, where issues of access to care are not as difficult. Life expectancy studies are not his particular field of expertise. )

Many people on this site seem to think that calculated life expectancies for people with HIV should be decreased to account for unobserved long term drug toxicity. What they fail to consider is that existing drug toxicity is already baked in to the calculations and that long term toxicity might just as well decline as increase -- after all, drugs evolve in favor of less toxic ones over time.

Plus I think the issue of toxicity is really one of those continuing myths about HIV treatment. While lipo and liver damage were nearly guaranteed with some of the earliest meds that is just not the case anymore, yet that idea persists - to the point of irrational fears for people starting meds. As I have pointed out before, people should really spend the time reading the information in the package inserts. Side effects (and toxicity) happen to very small amounts of patients on meds while the vast majority have few, if any, side effects at all. And it just gets better as time goes by and the meds evolve and improve.

From my understanding scare tactics are one of the least effective forms of prevention (most people never think it could happen to them).

ALL tactics have at least some success rate, so all tactics are effective. While some have better success than others, all have successes and therefore ALL campaigns are "worth" being used. In a world of millions of individuals what may change the opinions and actions of one person may not work on another. So it takes ALL types of campaigns to adequately reach a majority of people. sadly no matter the tactics or how many, some people will still not heed the warnings/instructions/etc. tactics that scare are just as useful and effective as tactics that are more informative.

These estimates are with today's resources, not taking into account possible advances of science. If we do take that into account, then I guess we could really expect a long and healthy life. Well, so I hope.

As for the campaigns, I agree scare tactics are the worst. They didn't work for most of us, did they? They were more effective in the 80s because you heard about people dying of AIDS here and there. Now, they have little effectivity and just reinforce the prejudice against people with HIV.

Also, I don't see a dilemma in being honest about the reality of HIV today. I mean, just because we may expect a "long and healthy life", does it mean HIV is no problem? We all know that it's no fun. I think showing the reality of it (the extra cares, meds for life, some problems that might arise, etc) is enough to discourage people from ignoring it. Knowledge is never enough and it sure helps to reduce prejudice.

The industry of drugs is very income-producing….it is a great business, they provide us to the laboratories with medicines because we can pay them… is much people who do not have access to the drugs and that never have access. Dr. Fauci continues speaking of the past of how the things have changed…. Dr. Fauci this very conforms to the drugs that there are and the drugs that come. it concern something of where the reservoir are if you have a treatment that eliminates the infection where it wants that this. The scientists are human and commit errors…Fauci is saving lives with drugs I am really happy to have access to treatment but it will be better to really focus in cure.But do not forget that drug industry produce drug for money is a big business…people who can not afford it dye.

Anthony Fauci, director of the U.S. Institute of Allergy and Infectious Diseases, agrees that it may DRACO potentially work against the HIV virus. But Fauci said that many effective drugs have also been available to treat HIV(YES BUT NOT CURE…WHY TO KEEP DEVELOPING MORE DRUGS INSTEAD OF DEVELOPING A CURE). So that these drugs would be useless against viral infections that do not have good medicine.(SO EVEN WHEN the DEVELOPER OF DRACO HAS PLANS TO APPLIED HIS DISCOVER WITH HIV…FAUCI SAID NO)

Fauci said in the present study there was a trend that allows the microbes to capture all the medicines as a universal flu vaccine that will protect against all strains of influenza. While DRACO has the potential to eliminate all types of viral infections.

“The more learn about the fundamentals of viral biology, biology of bacteria and other microbial biology, the more opportunities to develop broad-spectrum antiviral,” says Fauci.

ONE MORE BEHABIOUR OF FAUCIHE SAID THAT :

Dr. Anthony Fauci: The NIH is committed to funding any proposal that has scientific merit and passes peer review. (DRACO IS PUBLISHED IN A PEER REVIEW JOURNAL)Developing a standardized assay to measure reductions in HIV viral reservoir is an important issue and we are hopeful that we will receive excellent proposals.Thursday May 12, 2011 3:06 Dr. Anthony Fauci

SO DRACO IS NOT A PROPORSAL IT WAS ALRREADY SUPORTED BY NIHWHY A THERAPEUTIC APROACH HAS TO DELAY SO MUCHDRACO TECHNOLOGY COULD ERRADICATE THE VIRUS…THIS IS SIMPLE…YOU DO NOT HAVE TO Spent TIME TO SEE IF THE TREATMENT remove THE VIRUS OR NOT.

Plus I think the issue of toxicity is really one of those continuing myths about HIV treatment. While lipo and liver damage were nearly guaranteed with some of the earliest meds that is just not the case anymore, yet that idea persists - to the point of irrational fears for people starting meds. As I have pointed out before, people should really spend the time reading the information in the package inserts. Side effects (and toxicity) happen to very small amounts of patients on meds while the vast majority have few, if any, side effects at all. And it just gets better as time goes by and the meds evolve and improve.ALL tactics have at least some success rate, so all tactics are effective. While some have better success than others, all have successes and therefore ALL campaigns are "worth" being used. In a world of millions of individuals what may change the opinions and actions of one person may not work on another. So it takes ALL types of campaigns to adequately reach a majority of people. sadly no matter the tactics or how many, some people will still not heed the warnings/instructions/etc. tactics that scare are just as useful and effective as tactics that are more informative.

Rider says there are many more viruses he wants to test DRACO on, including the virus that causes AIDS. A broad spectrum antiviral drug that works against HIV could be especially useful since some people can develop resistance to anti-retroviral drugs.

Anthony Fauci, director of the U.S. Institute of Allergy and Infectious Diseases, agrees that DRACO could potentially work against the human immunodeficiency virus. But Fauci says a variety of effective drugs are already available to treat HIV.

“So, there isn’t a compelling need to have a drug like this for HIV," said Fauci. "It’s more relevant for those viruses for which we don’t have any good drugs, and there are plenty of those around.”

Fauci says there is a trend in microbial research now to develop catch-all drugs like a universal flu vaccine that would protect against all strains of influenza, and DRACO, with its potential to target and eliminate all types of viral infections.

“The more we learn about the fundamental basics of viral biology and bacterial biology and other microbial biologies, the more opportunities we have to develop interventions such as this particular apparently broad-spectrum antiviral," he said.

MIT’s Todd Rider predicts it could be another decade before DRACO is ready for general use.

"DRACO will also be tested on the HIV virus," said Rider. (in the original article, this was not a quote) A broad spectrum antiviral drug that works against HIV can be very useful because some people can develop resistance to anti-retroviral drugs (ARVs).

Anthony Fauci, director of the U.S. Institute of Allergy and Infectious Diseases, agrees that it may DRACO potentially work against the HIV virus. But Fauci said that many effective drugs have also been available to treat HIV. So that these drugs would be useless against viral infections that do not have good medicine. (really what he said was that since there are already good drugs against HIV, this (DRACO) could be more USEFUL - not useless - against a virus for which there weren't already drugs.)

Fauci said in research right now there is a tendency of microbes which allows all drugs can catch like a universal flu vaccine will protect against all strains of influenza. While DRACO has the potential to eliminate all kinds of virus infection.

"More and more to learn about the fundamental basics of biology, biological virus, bacteria and other Microbial Biology, more and more opportunities can develop antivirus with broad spectrum," said Fauci.(this is a confusing quote translation)

Either way, Fauci didn't not say that it wasn't worth persueing and DRACO is still being studied. As HIV is a retro-virus and not a virus, and as DRACO hasn't even been tried against HIV, I think Fauci was being cautiously and kindly optimistic - if all these quotes are being accurately reported. I think the article you linked was trying too hard to put a good spin on DRACO.

I was glad to see that the translation and the original did mention it could be as long as a decade for the studies and development of this drug. As it's only been used in a petri dish so far, there's no guarantee that DRACO will actually work at all in humans (or even work against HIV), be able to be harnassed into a medication, or get through trials. There are still plenty of times where this drug might fail, and a decade might even be a too-soon of a prediction to get through all the studies and human trials.

Something else to ponder Alex. In several other threads lately I've talked about the history of HIV. It probably took the first 10 of the 30 yrs that we've known about HIV, to just understand that the problem (all those deaths) were being caused by HIV and what the transmission route was. As soon as that information was known, things began to greatly change for the better. From the very beginning and all along in the course of this disease they have been looking for a cure. Just look through the Research thread to see all the venues that are currently being tested. There's already been a whole history of failed "cure" research too.

However, it would have been foolish, and deadly, to have ONLY looked for the cure in these 30 yrs. We would have had 20 more years of high death counts if HAART had not been developed. So today it is still a worthy path for more and better HAART to be developed (why stop until everyone has a one-a-day (or longer) pill with no side effects??) along with the many ways they are looking for a cure.

Not to mention that while they are looking for a cure and improving current medications, they are also researching to find a vaccine. Any breakthroughs in treatment or cure or vaccine would help change the dynamic of HIV treatment and produce positive changes in the patients that take medications and/or infected with HIV.